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Ever see a hospital bill?

Discussion in 'Internal Medicine and IM Subspecialties' started by mcindoe, Apr 26, 2007.

  1. mcindoe

    mcindoe 7+ Year Member

    Nov 13, 2004
    my apologies if this sounds at all like a lecture, but i only thought i'd post this to let you guys know of a few things that we don't and won't really think about once we start internship because it doesn't affect us directly, and we're never formally taught about it in med school. i don't know if you've ever seen an itemized hospital bill, but once i did it shocked me to learn about how much the cost of something can vary based on how the order is written in the chart, and since we'll all be writing our own orders pretty soon, i thought it might be helpful to consider a few ways that the wording of your orders can unintentionally result in hundreds of extra dollars being charged to the patient...but how are you supposed to know if no one tells you? that's why i wanted to share the following:

    -we all know that ordering labs is costly and that many frown upon ordering them unnecessarily, but if you forgot to order some routine labs but still need them, just know that adding "stat" to the order will almost double the cost for this "expedited" service that the hospital is providing.

    -sometimes it's tempting to just order a chem 7 or chem whatever because it saves you the time of writing out each lab you want. but sometimes all you really want to know about is the patient's Na and K or if that's the case, just order the ones you need. otherwise it's an extra $30 +/- a few bucks for each lyte or lab value that you order but don't need or more commonly don't even look at (e.g. a routine chem 7 was $240 or so on this bill i saw). similarly, just cause Ca/Mg/Phos are often listed together, it's easy to get in the habit of ordering the three when you might only be interested in finding out one of not ordering the other two could save the patient up to $100.

    -as with labs, any imaging orders will be several hundred dollars more if they're ordered as "stat". a bedside CXR may be your only option for some patients, but if they're able to be transported to radiology, you'll save them quite a bit of money for doing the latter.

    -if you're on autopilot and always are in the habit of ordering PT/OT to get your patients OOB, at many places one PT order will ensure that the physical therapist sees your patient not just once but for a few days. if you enter another PT order the next day, the PT will still see your patient anyway based on your prior order, but hospital billing will see that and charge the patient again for the service...and that charge can be anywhere from $300-$600.

    there are some others i can list at another time, and i'm sure we could all benefit if you have something to add. either way, i think it's best if we start thinking about this now, especially since old habits are hard to break, especially when we're tired and busy. hope this helps!
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  3. Mumpu

    Mumpu Burninator, MD 5+ Year Member

    Aug 1, 2004
    Labs are such a huge moneymaker for the hospital. When you order a sodium only, the lab runs a full chem7 but doesn't report the rest. The sweetest deal has to be the bloodbank though -- people give you blood for free and you get to sell it for thousands of dollars.
  4. carrigallen

    carrigallen 16th centry dutch painter 10+ Year Member

    Feb 27, 2003
    I agree, although I bet blood-banking itself is a bit expensive..batching, sorting, preparation, cross-matching, etc.
  5. blanche

    blanche #$%&*[email protected]!!#? 7+ Year Member

    Great points.

    Although I would never want to repeat the experience, I think being hospitalized and then dealing with the paperwork and billing nightmare that insued (thank you, medical student health plan) was probably one of the most telling experiences of my entire 4 years. Just try to guess what all of the 'misc supplies' charges are, for example. And when you actually have to pay for your services, you realize the sorts of #@%$% that those without resources (or medicaid) actually have to deal with, and this is without any prior training in navigating our medical system. Hospital billing departments are a nightmare, and if you are uninsured (which I wasn't but sure felt like) everything costs multiples more...
  6. mcindoe

    mcindoe 7+ Year Member

    Nov 13, 2004
    true, true....i learned from a similar experience (and the ensuing billing nightmare) how having health insurance is far less of a security blanket than one would think, particularly when it comes to finding out how many things aren't covered or how adept the insurance companies are at finding ways to avoid paying for things. the hospital screws you over by billing you obscene amounts of money for who knows what, and then the insurance company screws you and the hospital over by coming up with all sorts of excuses for why they're not liable for this or that charge, making it a long, drawn out battle that makes it feel like you're being punished for getting sick. medical insurance is like a mail-in like what it offers you but once you actually follow through with it and request what it promises, the wait and hassle and hoops you have to jump through in the process make it much less valuable than it originally seemed, and definitely far more complicated than it ought to be. the whole system is definitely broken and sadly doesn't seem like it'll be fixed anytime soon...
  7. blanche

    blanche #$%&*[email protected]!!#? 7+ Year Member

    this is a great comparision. and don't forget the most important part--if that rebate (insurance form with inflexible due date) gets 'lost' in the mailroom, you're screwed.

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